Author: James Fuccione

Sign Up for Virtual Lobby Days: Dec 5-6

The home care community needs to be involved and present a unified message as lawmakers work to address the impending “fiscal cliff.” During the post election “lame duck” session, Congress will be grappling with how to reduce burgeoning deficits and offset the costs of fixing the flawed Medicare physician payment formula, among a host of other fiscal issues. Home health copayments and payment cuts have been proposed as a means of deficit reduction and offsetting the cost of the physician fix.

Copayments have been proposed by a number of key players in the budget debate.  Specifically:

  • The National Commission on Fiscal Responsibility and Reform of 2010 (the “Bowles-Simpson plan”) recommended a uniform 20 percent copayment for all Medicare services. This would amount to a $600 copay to access an episode of Medicare home health care.
  • The Congressional Budget Office proposed a 10 percent home health copay as one of its budget options for deficit reduction, a proposal that received support from the Republican Study Committee.
  • The Medicare Payment Advisory Commission (MedPAC) has recommended a home health copay (as much as $150 per episode) for episodes not preceded by a hospital or nursing home stay.
  • The President’s September 2011 deficit reduction plan included a $100 home health copay for episodes not preceded by a hospital or nursing home stay, beginning in 2017 for newly eligible Medicare beneficiaries.  Further cuts in home health payments have also been proposed in these plans.

NAHC has scheduled a live and virtual “March on Washington” lobby day for December 5 and 6. The message to lawmakers is “Oppose Medicare home health copays and payment cuts.”

The Alliance will hold a free open conference call for members to review talking points and prepare for the virtual lobby days on Tuesday, December 4, at 3:00 p.m.  To register for this call, please email Stephanie Drakes.

We have stopped copays before, but the economic situation is dire and with the range of options on the table, the home health community needs to raise its voice collectively. Every advocacy group and every interest group will be weighing in, so remaining silent at such a critical time is not an option!

Alliance members can send a message using the NAHC Legislative Action Network (LAN).  Once you log onto the LAN, you can access talking points on home health copayments and get the Washington telephone numbers of your elected representatives.

Please encourage your colleagues, staff, friends, family and the families of your patients to visit the link above or call the office of your member of Congress and our Senators:

Sen. John Kerry – (202) 224-2742 / Boston office (617) 565-8519
Sen. Scott Brown – (202) 224-4543 / Boston office (617) 565-3170
Congressman Jim McGovern – (202) 225-6101 / Worcester office (508) 831-7356
Congressman John Tierney – (202) 225-8020 / Peabody office (978) 531-1669
Congresswoman Niki Tsongas (202) 225-3411 / Lowell Office (978) 459-0101
Congressman Ed Markey 202-225-2836 / Medford Office 781-396-2900
Congressman Mike Capuano (202) 225-5111 / Cambridge Office (617) 621-6208
Congressman Richard Neal (202) 225-5601 / Springfield office (413) 785-0325
Congressman John Olver (202) 225-5335 / Pittsfield Office (413)-442-0946
Congressman Stephen Lynch (202) 225-8273 / Boston office (617) 428-2000
Congressman Bill Keating (202) 225-3111 / Quincy Office (617) 770-3700

Return to www.thinkhomecare.org.

OIG Report: ALJs Need Training

Not surprisingly to any agencies involved in the TPL project, a new report from the Office of Inspector General of the US Dept. of Health & Human Services found a range in inconsistencies and shortcomings in the Administrative Law Judge level of the Medicare appeal process.

A sampling of some of the findings of the study:

  • Two State Medicaid agencies [one of which clearly is Massachusetts] filed more than 500 appeals each in 2010.  Many ALJ staff raised concerns about these frequent filers, noting that some of these appellants appeal every payment denial, and pointing out that these appellants have an incentive to appeal because the cost is minimal and a favorable decision is likely
  • The fully favorable [ALJ coverage decision] rate varied substantially by appellant type. For providers, it was 61 percent. In contrast, the fully favorable rate was just 22 percent for State Medicaid agencies.
  • ALJs tended to interpret Medicare policies less strictly than QICs
  • The favorable rate varied widely by ALJ.  According to many ALJ staff, different philosophies among ALJs contribute to the variation in fully favorable rates. They said that given the same facts and the same applicable Medicare policy, some ALJs would make decisions that are favorable to appellants, while others would not.

The report’s recommendations to CMS and the Office of Medicare Hearings and Appeals include:

  • Develop and Provide Coordinated Training on Medicare Policies to
  • ALJs and QICs
  • Identify and Clarify Medicare Policies That Are Unclear and
  • Interpreted Differently
  • Standardize Case Files and Make Them Electronic
  • Revise Regulations To Provide More Guidance to ALJs Regarding
  • the Acceptance of New Evidence
  • Improve the Handling of Appeals From Appellants Who Are Also
  • Under Fraud Investigation and Seek Statutory Authority To Postpone
  • These Appeals When Necessary
  • Seek Statutory Authority To Establish a Filing Fee
  • Implement a Quality Assurance Process To Review ALJ Decisions
  • Determine Whether Specialization Among ALJs Would Improve Efficiency.

Return to www.thinkhomecare.org.

State Reveals ICOs in Dual Eligible Care Demonstration

More than a month passed their anticipated announcement date of September 21st, the state’s Executive Office of Health and Human Services (EOHHS) named the Integrated Care Organizations, or ICO’s, that will be managing and directing both payment and care for the demonstration to integrate services for dual eligibles.

The six organizations are Blue Cross and Blue Shield of Massachusetts HMO Blue Inc. (BCBSMA), Boston Medical Center HealthNet Plan (BMCHP), Commonwealth Care Alliance (CCA), Fallon Total Care, LLC (FTC), Neighborhood Health Plan (NHP), Network Health, LLC. Only Network Health was picked to serve every county in the state and will be the only ICO in Nantucket and Martha’s Vineyard.

Aside from Network Health, all other ICO’s are listed in as few as three counties and as many as eleven.

These organizations were selected for full (F) or partial (P) Massachusetts counties as follows:

BCBSMA BMCHP CCA FTC NHP Network Health
Barnstable F F F F
Berkshire F F
Bristol F F F F
Dukes F
Essex F F F F F
Franklin F F F F
Hampden F F F F F
Hampshire F F F F F
Middlesex F F F F F F
Nantucket F
Norfolk F F F F F
Plymouth F F P F F
Suffolk F F F F F F
Worcester F F F F

These organizations will now be engaged in a “readiness review” over the next two months. As part of the review, EOHHS and CMS will require that the organizations demonstrate full readiness and meet operational requirements.  An ICO will not be able to accept enrollments without successfully completing the joint Readiness Review, negotiating and executing a three-way contract, and receiving any necessary state and federal approvals.

Return to www.thinkhomecare.org.

DHCFP Has Changed to CHIA

The state’s Division of Health Care Finance & Policy (DHCFP) is now an independent state agency called the Center for Health Information and Analysis (CHIA) thanks to the new Health Care Payment Reform Law (Chapter 224 of the Acts of 2012).

The new state agency will have most of the responsibilities pertaining to health care data collection, dissemination and analysis, but according to their website, “CHIA will also take on new roles in support of its mission to examine health care cost and quality information and provide objective data and analysis to assist in the formulation of health care policy.”

CHIA will continue to manage the All-Payer Claims Database and run the annual Cost Trends hearings, but will be collecting and analyzing data in particular that deals with how the new health care payment law is affecting cost trends. Last year, the Home Care Alliance sat on an expert panel to help provide a broader picture of cost trends in Massachusetts and the potential impact of Accountable Care Organizations.

HCA will continue to report on the implementation of Chapter 224 as information becomes available.

Return to www.thinkhomecare.org.

 

November is National Home Care Month – Help Us Celebrate!

Join the Home Care Alliance in celebrating National Home Care Month throughout November by visiting our new webpage www.thinkhomecare.org/homecaremonth.

On that site, the Alliance has posted materials to help home care agencies and advocates celebrate and raise awareness. There are templates for a press release, op-ed’s, and letters to the editor that can be sent to local media as well as downloadable posters that can be posted in your office and community.

Be sure to follow us on Facebook and Twitter where the Alliance will be posting a “Home Care Fact of the Day” each day in November, along with other important news and updates. We have 142 “Likes” and are aiming to get to 150 and beyond!

HCA has plenty of educational and training events in November so please be sure to check our busy calendar of events this month.

Finally, our radio campaign in partnership with WGBH is still ongoing so stay tuned to 89.7 FM or Classical New England (99.5 FM) to hear great sponsorships from HCA members.

For more info on how to celebrate and raise awareness, or if you would like assistance with the press materials, please contact James Fuccione at the Alliance.

Return to www.thinkhomecare.org.

Multimedia Home Care Ad Campiagn in Full Swing

The Home Care Alliance is engaged in its own campaign this fall.

The inaugural HCA Multimedia Campaign is in full swing this fall thanks to a partnership between the Alliance and WGBH where member home care agencies have the opportunity to “sponsor”  public radio programming. These sponsorships are mentioned on 89.7 WGBH (Boston Public Radio) as well as 99.5 Classical New England and direct listeners to a custom webpage with the participating member agencies.

Also rotating with other sponsors on the WGBH and Classical New England websites is a graphic that also directs people to the HCA’s custom webpage.

The sponsorships play continuously through the first week of November for participating member agencies and run on various times through the day.

These sponsorships promote the home health or home care agency, but also raise the profile of home care and generate interest in the industry at large. The listeners of these stations are overwhelmingly the demographic of people that are interested in learning more about or obtaining home care.

To hear a couple of the sample sponsorships, see the audio clips below:

Guest Post: Utilization of Post-Acute Services by ALF Residents

The following is a guest blog post on the utilization of post-acute services by residents of an assisted living facility written by Elizabeth Hogue, Esq. The author plans future articles on this subject so be sure to check back for updates!

As the number of years in which they have been in business increases, ALF’s are more eager to help their residents to “age in place.”  ALF’s often view availability of services from post-acute providers; including Medicare home care, private duty home care, hospice, and home medical equipment (HME); as essential to allow them to achieve this goal.  While ALF’s want to encourage utilization of these types of services by residents, ALF’s cannot lose sight of the fact that the healthcare industry is highly regulated.  With ever-increasing emphasis on fraud and abuse compliance, ALF’s and post-acute providers cannot afford to violate the law.

How can ALF’s encourage the use of services available from post-acute providers by residents?  What are the potential legal pitfalls that ALF’s and post-acute providers must avoid?  The most effective way to maximize utilization of these services may be to take a multi-pronged approach that includes:

1. Assignment of liaisons/coordinators from post-acute providers to ALF’s

Use of coordinators/liaisons at ALF’s raises issues related to violation of the federal anti-kickback statute.  This statute generally prohibits providers from either offering to give or actually giving anything to referral sources in order to induce referrals.  Consequently, liaisons and coordinators must be scrupulous about avoiding the provision of free services to ALF’s and/or their residents.  Possible violations include “staffing” an office with an RN who responds to requests from residents in their apartments or has “office hours” to address health conditions of residents.

Continue reading “Guest Post: Utilization of Post-Acute Services by ALF Residents”

New Info Coming Soon on Money Follows the Person Initiative

The Massachusetts version of the federal Money Follows the Person initiative, held a stakeholders meeting at the Worcester Public Library with a review of activity and a “heads-up” that an RFR will be coming out next month for the five coordinating entities that will manage money and services.

Dubbed Regional Coordinating Offices, or RCO’s, these newly formed entities will provide access to housing search for MFP transitional entities along with transition assistance itself as participant move from a facility to the community. RCO’s will also provide orientation and mobility training, assistive technology, and case management. The five RCO’s will chosen by January 2013 based on an RFR due out by this November.

In February 2011, CMS awarded a five-year Money Follows the Person Demonstration grant to Massachusetts. The funding will, according to the state’s office of Health and Human Services, will help transition more than 2,200 individuals out of nursing facilities, long-term care facilities, chronic care hospitals, and intermediate care facilities into community-based care.

HCA will continue to provide updates on this program, which are also available at on mass.gov here.

Return to www.thinkhomecare.org.

State Holds Health Payment Reform Info Session

Health care advocates and stakeholders packed and overflowed a large conference room meant to host an information session on the implementation progress of the new health care payment reform law.

Governor Patrick walked in mid-session and summed up the intent of the meeting where every state agency and department mentioned in the law was present to speak on their respective piece. The Governor explained that it took a lot of work to pass what he termed ‘a good bill’, but added that ‘now the real work begins.’ He said that it will take work on the part of government, providers, and stakeholders to ensure that the law is implemented effectively and the way in which it was intended.

To that end, Health and Human Services Secretary JudyAnn Bigby reported that the 11-member board of the Health Policy Commission, the main group charged with developing the policy necessary to implement the law, will be convened by November 5. The work of putting together other task forces and commissions, including those where the Home Care Alliance has the authority to name a representative, has already begun.

One of HCA’s victories in the legislation was the ability to name members on the Behavioral Health Task Force and the Commission to Review Public Payer Reimbursement Rates.

Other state agencies and their responsibilities are being reconfigured, including the Division of Health Care Financing becoming the Center for Health Information and Analysis. That group will be an independent state agency and so-called “pricing activities” relative to rate setting will move under the Executive Office of Health and Human Services.

The Alliance will provide updates as they become available and the state has an implementation website with more information at http://www.mass.gov/governor/agenda/healthcare/cost-containment/.

Return to www.thinkhomecare.org.

New Website Created on State Health Care Payment Law Implementation

The state has announced a new web page on Mass.gov that will serve as a clearinghouse for information as the state implements the new health care cost containment law signed by Governor Patrick in August.

The site will host important announcements about the new law as well as information on Grants & Demonstrations,Stakeholder Meetings andBoards, Commissions & Task Forces. 

Thanks to the advocacy efforts of the Home Care Alliance, the association has been given the authority to name members on the “Task Force Related to Behavioral, Substance Use Disorder, and Mental Health Treatment”  as Governor Deval Patrick, joined by Secretary Jay Gonzalez, Secretary JudyAnn Bigby, Rep. Steven Walsh, Rep. Ronald Mariano, Attorney General Martha Coakley, Speaker of the House Robert DeLeo, signs the health care cost containment bill in Nurses' Hall. well as the “Commission to Review Public Payer Reimbursement Rates.”

The website also announces meetings to inform stakeholders of progress and potential opportunities related to the new law so those interested are encouraged to check the site regularly and stay tuned to our blog for other important updates.

Return to www.thinkhomecare.org.